新发Ⅳ期乳腺癌患者手术价值探讨

陈璐艳; 王丽雪; 傅佩芬

doi:10.19401/j.cnki.1007-3639.2023.05.002

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新发Ⅳ期乳腺癌患者手术价值探讨

专家述评 | 更新时间：2025-12-31

- 新发Ⅳ期乳腺癌患者手术价值探讨
- The value of surgery in the patients with de novo stage Ⅳ breast cancer
- 中国癌症杂志 2023年33卷第5期页码：431-436
- 作者机构：
  
  浙江大学医学院附属第一医院乳腺外科，浙江杭州 310009
- 作者简介：
  
  [ "陈璐艳（ORCID: 0000-0002-3999-9953），硕士，主治医师。" ]
  [ "傅佩芬，主任医师，外科学博士，硕士研究生导师，浙江大学医学院附属第一医院乳腺外科主任。从事乳腺疾病诊治工作30年，致力于乳腺癌耐药机制及细胞免疫治疗研究，主持国家自然科学基金、浙江省重点研发计划项目等国家及省部级课题7项。目前在研项目国家自然科学基金面上项目及浙江省重点研发项目各1项，总经费达305万元。研发设计的乳腺癌腋窝淋巴结清扫压力胸衣，获批国家实用新型发明专利。以第一作者或通信作者在SCI收录期刊上发表乳腺疾病相关论文30余篇。先后担任中国临床肿瘤学会（Chinese Society of Clinical Oncology，CSCO）乳腺癌专家委员会常委、中国医药教育协会乳腺疾病专业委员会常委、中国医疗保健国际交流促进会乳腺疾病分会常委、中国抗癌协会乳腺癌专业委员会委员、中国医师协会外科医师分会乳腺外科医师委员会委员、中华医学会外科学分会乳腺外科学组委员、浙江省数理医学学会乳腺临床试验专业委员会主任委员等。参与《中国临床肿瘤学会（CSCO）乳腺癌诊疗指南》《中国早期乳腺癌前哨淋巴结活检手术临床实践指南（2022版）》《乳腺肿瘤整形与乳房重建专家共识》《中国浸润性乳腺癌诊治临床实践指南（2022版）》《中华医学会乳腺外科临床实践指南》《乳腺癌腔镜治疗专家共识与操作指导意见（2019版）》《乳腺及引流区域淋巴结介入超声若干临床常见问题中国专家共识（2021版）》《中国可视化经皮穿刺乳腺组织定位导丝与定位标记夹临床实践指南（2022版）》《乳腺癌靶向人表皮生长因子受体2酪氨酸激酶抑制剂不良反应管理共识》《妊娠相关性乳腺癌临床诊治专家共识（2020版）》等多部全国乳腺疾病诊疗指南与共识的修订，2021年获聘CSCO AI乳腺癌规范化诊疗项目首席专家。" ]
- 基金信息：
  
  国家自然科学基金面上项目(82172770)
- DOI：10.19401/j.cnki.1007-3639.2023.05.002
  中图分类号： R737.9
- 收稿：2023-01-31，
  
  修回：2023-05-04，
  
  纸质出版：2023-05-30
- 稿件说明：
移动端阅览
陈璐艳, 王丽雪, 傅佩芬. 新发Ⅳ期乳腺癌患者手术价值探讨[J]. 中国癌症杂志, 2023,33(5):431-436.

Luyan CHEN, Lixue WANG, Peifen FU. The value of surgery in the patients with de novo stage Ⅳ breast cancer[J]. China Oncology, 2023, 33(5): 431-436.
陈璐艳, 王丽雪, 傅佩芬. 新发Ⅳ期乳腺癌患者手术价值探讨[J]. 中国癌症杂志, 2023,33(5):431-436. DOI： 10.19401/j.cnki.1007-3639.2023.05.002.

Luyan CHEN, Lixue WANG, Peifen FU. The value of surgery in the patients with de novo stage Ⅳ breast cancer[J]. China Oncology, 2023, 33(5): 431-436. DOI： 10.19401/j.cnki.1007-3639.2023.05.002.

摘要

乳腺癌是全世界常见的恶性肿瘤之一，其中约6%的患者为新发Ⅳ期乳腺癌，是不可治愈的。传统意义上外科手术的作用仅限于缓解患者症状，改善生活质量，降低肿瘤负荷。随着全身治疗手段的进步，通过多学科团队制订综合治疗方案，仅有寡转移灶的Ⅳ期乳腺癌患者往往能获得长期生存，而原发灶及转移灶的R0切除可以延长无进展生存期（progression-free survival，PFS），可能会带来生存获益，因此是否需要行乳腺癌原发灶及转移灶的手术治疗成为临床热点，并存在较大争议。本文对新发Ⅳ期乳腺癌患者的手术价值进行深入探讨。

Abstract

Breast cancer is one of the common malignant tumors in the world. About 6% of the patients are

de novo

stage Ⅳ breast cancer

which is incurable. Traditionally

the role of surgery has been confined to relieving symptoms

improving quality of life and reducing tumor load. Nowadays

a multidisciplinary team is a prerequisite for optimal management

and patients with oligometastatic lesion always live for a long time. R0 resection of the primary and metastatic foci can extend the time of progression-free survival (PFS)

which may bring survival benefits. Therefore

whether to perform surgery has become a hot clinical issue. This article deeply discussed extensively the surgical value in

de novo

stage Ⅳ breast cancer patients.

关键词

Keywords

references

SUNG H , FERLAY J , SIEGEL R L , et al . Global cancer statistics 2020: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries [J ] . CA Cancer J Clin , 2021 , 71 ( 3 ): 209 - 249 . DOI: 10.3322/caac.v71.3 http://doi.org/10.3322/caac.v71.3 https://onlinelibrary.wiley.com/toc/15424863/71/3 https://onlinelibrary.wiley.com/toc/15424863/71/3

GIAQUINTO A N , SUNG H , MILLER K D , et al . Breast cancer statistics, 2022 [J ] . CA A Cancer J Clin , 2022 , 72 ( 6 ): 524 - 541 . DOI: 10.3322/caac.v72.6 http://doi.org/10.3322/caac.v72.6 https://onlinelibrary.wiley.com/toc/15424863/72/6 https://onlinelibrary.wiley.com/toc/15424863/72/6

SIEGEL R L , MILLER K D , JEMAL A . Cancer statistics, 2015 [J ] . CA A Cancer J Clin , 2015 , 65 ( 1 ): 5 - 29 . DOI: 10.3322/caac.21254 http://doi.org/10.3322/caac.21254 http://doi.wiley.com/10.3322/caac.21254 http://doi.wiley.com/10.3322/caac.21254

ZHENG R S , ZHANG S W , ZENG H M , et al . Cancer incidence and mortality in China, 2016 [J ] . J Natl Cancer Center , 2022 , 2 ( 1 ): 1 - 9 . DOI: 10.1016/j.jncc.2022.02.002 http://doi.org/10.1016/j.jncc.2022.02.002 https://linkinghub.elsevier.com/retrieve/pii/S2667005422000047 https://linkinghub.elsevier.com/retrieve/pii/S2667005422000047

ARCIERO C , LIU Y , GILLESPIE T , et al . Surgery and survival in patients with stage Ⅳ breast cancer [J ] . Breast J , 2019 , 25 ( 4 ): 644 - 653 . DOI: 10.1111/tbj.2019.25.issue-4 http://doi.org/10.1111/tbj.2019.25.issue-4 https://onlinelibrary.wiley.com/toc/15244741/25/4 https://onlinelibrary.wiley.com/toc/15244741/25/4

ZHENG A , GUO B L , ZHANG J G , et al . Clinical information and management status of de novo stage Ⅳ breast cancer patients: a Chinese multicenter investigation (CSBrS-002) [J ] . Chin Med J (Engl) , 2021 , 134 ( 13 ): 1569 - 1575 .

MALINOWSKI C , LEI X D , ZHAO H , et al . Association of Medicaid expansion with mortality disparity by race and ethnicity among patients with de novo stage Ⅳ breast cancer [J ] . JAMA Oncol , 2022 , 8 ( 6 ): 863 - 870 . DOI: 10.1001/jamaoncol.2022.0159 http://doi.org/10.1001/jamaoncol.2022.0159 https://jamanetwork.com/journals/jamaoncology/fullarticle/2790997 https://jamanetwork.com/journals/jamaoncology/fullarticle/2790997

MALMGREN J A , MAYER M , ATWOOD M K , et al . Differential presentation and survival of de novo and recurrent metastatic breast cancer over time : 1990-2010[J ] . Breast Cancer Res Treat , 2018 , 167 ( 2 ): 579 - 590 . DOI: 10.1007/s10549-017-4529-5 http://doi.org/10.1007/s10549-017-4529-5 http://link.springer.com/10.1007/s10549-017-4529-5 http://link.springer.com/10.1007/s10549-017-4529-5

GRADISHAR W J , MORAN M S , ABRAHAM J , et al . Breast cancer, version 3.2022, NCCN clinical practice guidelines in oncology [J ] . J Natl Compr Canc Netw , 2022 , 20 ( 6 ): 691 - 722 . DOI: 10.6004/jnccn.2022.0030 http://doi.org/10.6004/jnccn.2022.0030 https://jnccn.org/view/journals/jnccn/20/6/article-p691.xml https://jnccn.org/view/journals/jnccn/20/6/article-p691.xml

中华医学会外科学分会 . 乳腺外科临床实践指南(2022版) [M ] . 人民卫生出版社 , 2022 .

Surgery Branch of Chinese Medical Association . Practice guidelines of Chinese society of breast surgery (2022) [M ] . People’s Medical Publishing House , 2022 .

GENNARI A , ANDRÉ F , BARRIOS C H , et al . ESMO clinical practice guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer [J ] . Ann Oncol , 2021 , 32 ( 12 ): 1475 - 1495 . DOI: 10.1016/j.annonc.2021.09.019 http://doi.org/10.1016/j.annonc.2021.09.019

SI Y R , YUAN P , HU N L , et al . Primary tumor surgery for patients with de novo stage Ⅳ breast cancer can decrease local symptoms and improve quality of life [J ] . Ann Surg Oncol , 2020 , 27 ( 4 ): 1025 - 1033 . DOI: 10.1245/s10434-019-08092-2 http://doi.org/10.1245/s10434-019-08092-2

YU Y F , HONG H M , WANG Y , et al . Clinical evidence for locoregional surgery of the primary tumor in patients with de novo stage Ⅳ breast cancer [J ] . Ann Surg Oncol , 2021 , 28 ( 9 ): 5059 - 5070 . DOI: 10.1245/s10434-021-09650-3 http://doi.org/10.1245/s10434-021-09650-3

KHAN S A , ZHAO F M , GOLDSTEIN L J , et al . Early local therapy for the primary site in de novo stage Ⅳ breast cancer: results of a randomized clinical trial (EA2108) [J ] . J Clin Oncol , 2022 , 40 ( 9 ): 978 - 987 . DOI: 10.1200/JCO.21.02006 http://doi.org/10.1200/JCO.21.02006 https://ascopubs.org/doi/10.1200/JCO.21.02006 https://ascopubs.org/doi/10.1200/JCO.21.02006

KHAN S A , STEWART A K , MORROW M . Does aggressive local therapy improve survival in metastatic breast cancer? [J ] . Surgery , 2002 , 132 ( 4 ): 620-6;discussion626.

BABIERA G V , RAO R , FENG L , et al . Effect of primary tumor extirpation in breast cancer patients who present with stage Ⅳ disease and an intact primary tumor [J ] . Ann Surg Oncol , 2006 , 13 ( 6 ): 776 - 782 . DOI: 10.1245/ASO.2006.03.033 http://doi.org/10.1245/ASO.2006.03.033 http://link.springer.com/10.1245/ASO.2006.03.033 http://link.springer.com/10.1245/ASO.2006.03.033

RAPITI E , VERKOOIJEN H M , VLASTOS G , et al . Complete excision of primary breast tumor improves survival of patients with metastatic breast cancer at diagnosis [J ] . J Clin Oncol , 2006 , 24 ( 18 ): 2743 - 2749 . DOI: 10.1200/JCO.2005.04.2226 http://doi.org/10.1200/JCO.2005.04.2226

BAFFORD A C , BURSTEIN H J , BARKLEY C R , et al . Breast surgery in stage Ⅳ breast cancer: impact of staging and patient selection on overall survival [J ] . Breast Cancer Res Treat , 2009 , 115 ( 1 ): 7 - 12 . DOI: 10.1007/s10549-008-0101-7 http://doi.org/10.1007/s10549-008-0101-7 http://link.springer.com/10.1007/s10549-008-0101-7 http://link.springer.com/10.1007/s10549-008-0101-7

LANE W O , THOMAS S M , BLITZBLAU R C , et al . Surgical resection of the primary tumor in women with de novo stage Ⅳ breast cancer: contemporary practice patterns and survival analysis [J ] . Ann Surg , 2019 , 269 ( 3 ): 537 - 544 . DOI: 10.1097/SLA.0000000000002621 http://doi.org/10.1097/SLA.0000000000002621 https://journals.lww.com/00000658-201903000-00024 https://journals.lww.com/00000658-201903000-00024

SORAN A , OZMEN V , OZBAS S , et al . Primary surgery with systemic therapy in patients with de novo stage Ⅳ breast cancer: 10-year follow-up; protocol MF07-01 randomized clinical trial [J ] . J Am Coll Surg , 2021 , 233 ( 6 ): 742 - 751 .e5. DOI: 10.1016/j.jamcollsurg.2021.08.686 http://doi.org/10.1016/j.jamcollsurg.2021.08.686 https://journals.lww.com/10.1016/j.jamcollsurg.2021.08.686 https://journals.lww.com/10.1016/j.jamcollsurg.2021.08.686

BADWE R , PARMAR V , HAWALDAR R , et al . Abstract S2-02: surgical removal of primary tumor and axillary lymph nodes in women with metastatic breast cancer at first presentation: a randomized controlled trial [J ] . Cancer Res , 2013 , 73 ( 24_Supplement ): S2 - 2 .

BADWE R , HAWALDAR R , NAIR N , et al . Locoregional treatment versus no treatment of the primary tumour in metastatic breast cancer: an open-label randomised controlled trial [J ] . Lancet Oncol , 2015 , 16 ( 13 ): 1380 - 1388 . DOI: 10.1016/S1470-2045(15)00135-7 http://doi.org/10.1016/S1470-2045(15)00135-7

KING T A , LYMAN J P , GONEN M , et al . Prognostic impact of 21-gene recurrence score in patients with stage Ⅳ breast cancer: TBCRC 013 [J ] . J Clin Oncol , 2016 , 34 ( 20 ): 2359 - 2365 . DOI: 10.1200/JCO.2015.63.1960 http://doi.org/10.1200/JCO.2015.63.1960 https://ascopubs.org/doi/10.1200/JCO.2015.63.1960 https://ascopubs.org/doi/10.1200/JCO.2015.63.1960

RAO R , FENG L , KUERER H M , et al . Timing of surgical intervention for the intact primary in stage Ⅳ breast cancer patients [J ] . Ann Surg Oncol , 2008 , 15 ( 6 ): 1696 - 1702 . DOI: 10.1245/s10434-008-9830-4 http://doi.org/10.1245/s10434-008-9830-4 http://link.springer.com/10.1245/s10434-008-9830-4 http://link.springer.com/10.1245/s10434-008-9830-4

ZHU S Y . Exploring the value of additional primary tumour excision combined with systemic therapy administered in different sequences for patients with de novo metastatic breast cancer [J ] . Breast J , 2022 , 2022 : 5049445 .

KOMMALAPATI A , TELLA S H , GOYAL G , et al . A prognostic scoring model for survival after locoregional therapy in de novo stage Ⅳ breast cancer [J ] . Breast Cancer Res Treat , 2018 , 170 ( 3 ): 677 - 685 . DOI: 10.1007/s10549-018-4802-2 http://doi.org/10.1007/s10549-018-4802-2

GERA R , CHEHADE H E L H , WAZIR U , et al . Locoregional therapy of the primary tumour in de novo stage Ⅳ breast cancer in 216 066 patients: a meta-analysis [J ] . Sci Rep , 2020 , 10 ( 1 ): 2952 . DOI: 10.1038/s41598-020-59908-1 http://doi.org/10.1038/s41598-020-59908-1

POCKAJ B A , WASIF N , DUECK A C , et al . Metastasectomy and surgical resection of the primary tumor in patients with stage Ⅳ breast cancer: time for a second look? [J ] . Ann Surg Oncol , 2010 , 17 ( 9 ): 2419 - 2426 . DOI: 10.1245/s10434-010-1016-1 http://doi.org/10.1245/s10434-010-1016-1 http://link.springer.com/10.1245/s10434-010-1016-1 http://link.springer.com/10.1245/s10434-010-1016-1

BILANI N , ELSON L , LIANG H , et al . Effect of surgery at primary and metastatic sites in patients with stage Ⅳ breast cancer [J ] . Clin Breast Cancer , 2021 , 21 ( 3 ): 170 - 180 . DOI: 10.1016/j.clbc.2020.08.008 http://doi.org/10.1016/j.clbc.2020.08.008 https://linkinghub.elsevier.com/retrieve/pii/S1526820920302147 https://linkinghub.elsevier.com/retrieve/pii/S1526820920302147

BILANI N , YAGHI M , SINGH JABBAL I , et al . Survival benefit of a combined surgical approach in patients with metastatic breast cancer [J ] . J Surg Oncol , 2021 , 124 ( 8 ): 1235 - 1241 . DOI: 10.1002/jso.v124.8 http://doi.org/10.1002/jso.v124.8 https://onlinelibrary.wiley.com/toc/10969098/124/8 https://onlinelibrary.wiley.com/toc/10969098/124/8

HELLMAN S , WEICHSELBAUM R R . Oligometastases [J ] . J Clin Oncol , 1995 , 13 ( 1 ): 8 - 10 . DOI: 10.1200/JCO.1995.13.1.8 http://doi.org/10.1200/JCO.1995.13.1.8

CARDOSO F , PALUCH-SHIMON S , SENKUS E , et al . 5th ESO-ESMO international consensus guidelines for advanced breast cancer (ABC 5) [J ] . Ann Oncol , 2020 , 31 ( 12 ): 1623 - 1649 . DOI: 10.1016/j.annonc.2020.09.010 http://doi.org/10.1016/j.annonc.2020.09.010 https://linkinghub.elsevier.com/retrieve/pii/S0923753420424603 https://linkinghub.elsevier.com/retrieve/pii/S0923753420424603

LACAZE J L , AZIZA R , CHIRA C , et al . Diagnosis, biology and epidemiology of oligometastatic breast cancer [J ] . Breast , 2021 , 59 : 144 - 156 . DOI: 10.1016/j.breast.2021.06.010 http://doi.org/10.1016/j.breast.2021.06.010 https://linkinghub.elsevier.com/retrieve/pii/S0960977621004069 https://linkinghub.elsevier.com/retrieve/pii/S0960977621004069

BILANI N , YAGHI M , MAIN O , et al . Metastasectomy versus radiation of secondary sites in stage Ⅳ breast cancer: analysis from a national cancer registry [J ] . Breast , 2021 , 60 : 185 - 191 . DOI: 10.1016/j.breast.2021.10.005 http://doi.org/10.1016/j.breast.2021.10.005 https://linkinghub.elsevier.com/retrieve/pii/S0960977621009759 https://linkinghub.elsevier.com/retrieve/pii/S0960977621009759

IMOTO S , WANG K , BI X W , et al . Survival advantage of locoregional and systemic therapy in oligometastatic breast cancer: an international retrospective cohort study (OLIGO-BC1) [J ] . Breast Cancer , 2023 , 30 ( 3 ): 412 - 423 . DOI: 10.1007/s12282-023-01436-7 http://doi.org/10.1007/s12282-023-01436-7

SADOT E , LEE S Y , SOFOCLEOUS C T , et al . Hepatic resection or ablation for isolated breast cancer liver metastasis: a case-control study with comparison to medically treated patients [J ] . Ann Surg , 2016 , 264 ( 1 ): 147 - 154 . DOI: 10.1097/SLA.0000000000001371 http://doi.org/10.1097/SLA.0000000000001371

CHMURA S J , WINTER K A , WOODWARD W A , et al . NRG-BR002: a phase ⅡR/Ⅲ trial of standard of care systemic therapy with or without stereotactic body radiotherapy (SBRT) and/or surgical resection (SR) for newly oligometastatic breast cancer (NCT02364557) [J ] . J Clin Oncol , 2022 , 40 : 1007 . DOI: 10.1200/JCO.2022.40.16_suppl.1007 http://doi.org/10.1200/JCO.2022.40.16_suppl.1007 https://ascopubs.org/doi/10.1200/JCO.2022.40.16_suppl.1007 https://ascopubs.org/doi/10.1200/JCO.2022.40.16_suppl.1007

ZHENG C , YU Z G , CHINESE SOCIETY OF BREAST SURGERY . Clinical practice guidelines for pre-operative evaluation of breast cancer: Chinese Society of Breast Surgery (CSBrS) practice guidelines 2021 [J ] . Chin Med J (Engl) , 2021 , 134 ( 18 ): 2147 - 2149 .

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